eFAQ-3: "Do you take insurance?"
Short answer: no, not directly.
Long answer: read on! :)
I formed my business as a cash-pay practice, and I fully intend to keep it that way, for reasons which I will describe below. I do not contract with any insurance companies, and most consider me an “out of network provider”.
Does this mean you can’t use your insurance benefits to work with me? Not necessarily. It means that my clients pay me upfront for all services/costs, and receive an invoice that shows proof of payment to Immersion PT. Sometimes this is all you need in order to use your HSA or FSA. If you are looking for reimbursement from your insurance company itself, you may need a document that’s a little more robust, which I can provide at your request. This form has all of the information your insurance company should need in order to make their decision on reimbursement, or applying the cost toward your deductible.
OK … so, why would you pay me if you can go somewhere else and simply pay a co-pay, no extra forms needed?
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Let’s take this example to compare costs and time to help you guide this decision.
Traditional outpatient insurance-based physical therapy clinic:
- Co-payment plan vs. high deductible plan
o Co-pays range from $20-60 per visit
o High-D: you pay the entire cost of the visit, which ranges from $65-100+ depending on the specific contract established between the company and clinic
o For the sake of simplicity here, let’s use $40 as our number to compare
- Visits
o Typically 2-3 times per week for 6-8 weeks; average total visits is about 12
o Many cases in a traditional setting are not initiated until after you’ve seen your primary care provider, had imaging done, AND seen a specialist (orthopedist) – because insurance companies want “all bases covered” before you even get to the PT and start feeling better!
- 1:1 time with your therapist at each session
o 10 minutes…maybe? (this will depend on where you fall in the therapist’s schedule, and if the therapist is double- or triple-booked at the time you’re there)
o Note: I’m giving this number based solely on my own experience in clinics of this type.
- Interruptions in care:
o Potentially disrupted by insurance “releasing” only 3-4 visits at a time or requiring authorization to continue.
TOTAL: $480 for 120 minutes of 1:1 time in 12 visits over the course of 2 months.
(plus drive time to/from appointments, which becomes even more complicated if you have childcare to arrange too!)
RESULT: you feel better and get back to doing what you love.
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Cash-based mobile physical therapy clinic (that’s me!)
- Out of pocket payment in full for all services
o For runners (most of my clients), I charge $200 for the initial visit / evaluation, and $150 for follow-up visits
- Visits
o Typically once every 1-2 weeks for 3-4 weeks; average total visits is about 2
o In New York State, you can work with a physical therapist for 10 visits or 30 days (whichever comes first) without a referral from a physician. If requested, I can send documentation to your physician, and I can certainly help facilitate a referral if, for some reason, we need to extend beyond 30 days.
- 1:1 time with your therapist at each session
o 60 minutes!
o Since I come to your house, I am never double-booked. I plan my visits so I am not pressed for time, should we need to spend a bit longer together on any given day.
- Interruptions in care:
o This may occur if we need to extend beyond 30 days and are waiting for a plan of care that has been reviewed, signed and returned by your physician.
o Our 1:1 time may have slight distractions from your son needing a snack or your cat wanting a quick snuggle – but hey, that’s part of life
TOTAL: $350 for 120 minutes of 1:1 time in 2 visits over the course of 1 month.
RESULT: you feel better and get back to doing what you love.
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BOTH of these situations/environments will also likely include some homework – exercises or drills to facilitate recovery, improvement and return to your normal or desired functional level. I will also point out that BOTH of these situations will likely result in your recovery, and I’m not here to knock down therapists who are working in traditional settings because there are some really fantastic therapists out there in those clinics! But, they are at the mercy of the insurance companies – sometimes there are limits on how many visits you can have, or what goals are “acceptable” (hint: running isn’t usually considered a necessary daily function, as much as we runners try to argue that it is), and even what interventions can be used during a session, and how many patients must be seen in a work day.
Healthcare has become a game, and I’m not willing to play that game with your health and goals on the line.
Because I am your physical therapist. I am here for YOU.
I love working with you, and the structure of my business allows me to do that. I can offer you high-quality and evidence-based care, be completely present with you during our sessions, and be available to you for quick questions outside of our scheduled time. I can see you at 6am on a Wednesday before work, at 8pm on a Saturday before your Sunday long run, or at 10am on a Tuesday when you’re lacing up for a track workout.
I can do these things because I own this practice.
I will do these things because I care about you.
The choice is yours.
I am here when you are ready.
-Megan R. James, PT DPT
Immersion PT // Owner, Physical Therapist & Run Coach